2005—2006年我国九家教学医院分离的常见呼吸道病原菌的耐药监测研究

Resistance surveillance of common community respiratory pathogens isolated from 9 teaching hospitals in China,2005-2006

目的调查2005—2006年中国社区呼吸道常见病原菌的耐药性。方法收集2005年1月—2006年9月全国9家医院社区呼吸道感染患者中分离的417株肺炎链球菌、208株流感嗜血杆菌、76株卡它莫拉菌和66株 A 群 B 溶血链球菌。琼脂稀释法测定莫西沙星等10种抗菌药物的最低抑菌浓度(MICs)。结果全国9家医院,青霉素中介的肺炎链球菌(PISP)为23.0%,青霉素耐药的(PRSP)为24.5%。来自儿童的肺炎链球菌对青霉素的敏感性明显低于成人组(30.6%vs.64.5%,P<0.001)。成人组中,上海瑞金医院 PISP 和 PRSP 明显高于其他8家医院(PISP 46.7%vs.15.3%,40.O%vs.17.3%,P=0.002)。青霉素对417株肺炎链球菌的 MIC 范围为0.008～4μg/ml。PRSP对头孢克洛、头孢丙烯、阿莫西林/克拉维酸和头孢曲松的敏感性分别为2.9%、2.9%、53.9%、58.8%,未发现对莫西沙星和左氧氟沙星不敏感的 PRSP。19.2%的流感嗜血杆菌和92.1%的卡它莫拉菌产生β内酰胺酶。流感嗜血杆菌对头孢克洛、头孢丙烯的敏感性(88.9%、92.3%)低于其对阿莫西林/克拉维酸、头孢曲松、阿奇霉素、左氧氟沙星、莫西沙星的敏感性(99.5%～100%)。卡它莫拉菌对上述药物的敏感性为92.1%～100%。9家医院流感嗜血杆菌β内酰胺酶的发生率最高的是杭州(41.9%)、广州(37.5%),其次是上海(26.3%～29.6%)、武汉(13.0%),最低的是北京和沈阳(≤3.3%);成人组流感嗜血杆菌的产酶率高于儿童组(22.1%vs.11.1%,P<0.05)。未发现对青霉素耐药的 A 群β溶血链球菌。肺炎链球菌、A 群β溶血链球菌对阿奇霉素耐药率高于75%。莫西沙星对肺炎链球菌、A 群β溶血链球菌的 MICs 比左氧氟沙星低4～8倍。结论不同年龄组、不同地区肺炎链球菌和流感嗜血杆菌的耐药性均有差异。革兰阳性球菌对大环内酯类的高耐药性值得关注,莫西沙星对呼吸道病原菌有优秀的抗菌活性。

Objective To investigate antimicrobial agents resistance of common community respiratory pathogens isolated in China, 2005-2006. Methods 417 isolates of Streptococcus pneumoniae, 208 Haemophilus influenzae, 76 Moraxella catarrhalis, and 66 Group A β-haemolytic Streptococci were collected from patients with community-acquired respiratory tract infections at 9 big teaching hospitals in China from January 2005 to September 2006. Agar dilution method was used to determine the minimal inhibitory concentration （MICs） of moxifloxacin and other 9 antibiotics against these isolates. Results Penicillin- intermediate S. pneumoniae （PISP） was 23.0% and penicillin-resistant S. pneumoniae （ PRSP ） was 24. 5% at 9 hospitals in China. Susceptibility to penicillin in S. pneumoniae differed significantly between children and adults （30. 6% vs. 64. 5 %, P 〈 0.001 ）. Among the adults group, the prevalence of PISP and PRSP were higher than those of other 8 hospitals （ PISP 46.7% vs. 15.3%, 40. 0% vs. 17. 3% , P =0. 002）. Penicillin MICs ranged from 0. 008 to 4 μg/ml. Susceptibility rates of PRSP to cefaclor, cefprozil, amoxicillin/clavulanate and ceftriaxone were 2. 9%, 2. 9%, 53.9% and 58. 8%, respectively. No PRSP was found to be resistant to levofloxacin and moxifloxacin. 19. 2% of H. influenzae and 92. 1% of M. catarrhalis produced β-lactamases. The susceptibility of cefaclor and cefprozil in H. influenzae was lower than those of amoxicillin/clavulanate, ceftriaxone, azithromycin, levofloxacin and moxifloxacin （ 88. 9% - 92. 3% vs. 99. 5% to 100% ）. The susceptibility of the above antimicrobials in M. catarrhalis ranged form 92. 1% to 100%. The prevalence of β-lactamases in H. influenzae was highest in Hongzhou （41.9%） and Guangzhou （37. 5% ）, followed by Shanghai （26. 3%-29. 6% ） ,Wuhan （ 13. 0% ）, Beijing and Shenyang （ 〈 3.3% ）. The prevalence of β-lactamases in H. influenzae was significantly higher in adults than in children （22. 1% vs. 11.1% ,P 〈0. 05）. No Group A β-haemolytic Streptococci isolates were resistant to penicillin. The resistance rate of S. pneumoniae and Group A β-haemolytic Streptococci to azithromycin was higher than 75%. Moxifloxacin MICs against S. pneumoniae, Group A β-haemolytic Streptococci were 4-8 fold lower than levofloxacin. Conclusions Antimicrobial resistance in S. pneumoniae and H. influenzae differs in different age groups and different areas. It brings concerns that high macrolides resistance was found in gram-positive cocci. Moxifloxacin has an excellent activity against respiratory pathogens.